Predictors of sustained remission in patients with early rheumatoid arthritis treated according to an aggressive treat-to-target protocol

N, Paulshus Sundlisæter; Olsen, I.C.; Aga, Anna‐Birgitte; Hb, Hammer; Uhlig, Till; D, van der Heijde; Kvien, TK; Lillegraven, Siri; Haavardsholm, Espen A

doi:10.1093/rheumatology/key202

Cited by 21 publications

(16 citation statements)

References 92 publications

(105 reference statements)

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“…A Spain‐based retrospective study showed SR was achieved in 46% of early RA patients . In the ARCTIC trial, all patients fulfilled the 2010 criteria and treated in accordance to T2T strategy, 53% of patients experienced DAS28 SR at three consecutive visits from 16 to 24 months . In our study, both univariate and multivariate analyses indicated T2T strategy as a strong positive factor (HR 1.51‐1.64) of SR defined by whichever criteria applied.…”

Section: Discussionsupporting

confidence: 49%

“…Three cohorts from Britain and the Netherlands have sequentially confirmed that ACPA positivity independently predicted low frequency of drug‐free SR . No association between RF/ACPA and SR defined as remission longer than 6 months, was reported in most subsequent studies from Canada, Korea, Sweden, Spain, and the Netherlands . However, a very recent study showed combined ACPA and RF positivity was associated with higher possibility of SR and shorter time to achieving SR .…”

Section: Discussionmentioning

confidence: 97%

“…To date, there are several cohort studies reporting the rates of SR from 3% to 53%, mainly due to the different definitions of SR . Although some of them further explored the relevant prognostic factors, obvious inconsistencies exist in the effect of gender, serological antibodies, baseline disease activity, and initial treatment regimens . Moreover, participants in nearly all previous reports were exclusively diagnosed according to the 1987 American College of Rheumatology (ACR) classification criteria, instead of 2010 ACR/European League Against Rheumatism (EULAR) criteria and were treated in the context of routine care, instead of tight control under treat‐to‐target (T2T) strategies.…”

Section: Introductionmentioning

confidence: 99%

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Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018

Xie

Zhang

et al. 2019

Int J of Rheum Dis

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Aim To investigate the prevalence and predictors of sustained remission (SR) in an unselected Chinese rheumatoid arthritis (RA) population. Patients and methods Medical records of RA patients from 2009 to 2016 were retrospectively reviewed. Clinical remission was defined according to Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28‐ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and Boolean criteria. Remission persisting for at least 6 months was regarded as SR (6‐month SR). Kaplan‐Meier method and Cox regression analyses were performed to plot cumulative possibility of achieving 6‐month SR and to identify predictors. Results Seven hundred and seventy‐nine patients contributing 7958 clinic visits were included. During the follow‐up period, nearly half of patients achieved 6‐month SR according to DAS28‐ESR (51.6%), CDAI (45.6%), SDAI (44.0%), as well as Boolean definitions (42.4%). Median time periods to 6‐month SR were respectively 20.5, 28.7, 30.6, and 32.9 months based on the above criteria. Specifically, 29.4% to 41.2% of patients achieved 6‐month SR at least once in the first year of follow‐up, depending on instruments. Multivariate Cox regression indicated that increasing age, longer disease duration, higher baseline disease activity were independently correlated with reduced possibility of 6‐month SR assessed by nearly all definitions. Conversely, male, early RA, disease‐modifying antirheumatic drug‐naïve and lower disease activity scores in remission measured by corresponding criteria positively contributed to SR. Importantly, treat‐to‐target (T2T) adherence therapy and shorter time to remission were identified as stable determinants of SR across all definitions. Conclusions Achieving 6‐month SR was not uncommon in daily practice. Male, early RA, treatment‐naïve, T2T application, shorter time to remission, and lower disease activity scores in remission increased the occurrence of SR, while increasing age, longer disease duration, and higher baseline disease activity reduced the chance of remission sustainability.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018

Xie

Zhang

et al. 2019

Int J of Rheum Dis

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“…A recent clinical trial has confirmed that RF was associated with disease remission, but ACPA positivity was not associated with sustained remission. [ 26 ] Hence, we have evaluated the prevalence and severity of PD in patients with established RA and OA in this study. Furthermore, whether the contribution RF and CRP alters the disease activity of periodontitis was assessed.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and severity of periodontitis in patients with established rheumatoid arthritis and osteoarthritis

Disale

Zope

Suragimath

et al. 2020

J Family Med Prim Care

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Introduction: Periodontitis is associated with many chronic health conditions including diabetes, cardiovascular disease, and rheumatoid arthritis (RA). RA and periodontitis have similarities in inflammatory mechanism, morphology, and histopathology. Osteoarthritis (OA) is a chronic, multifactorial degenerative disease characterized by the deterioration of cartilage in joints. Objective: The aim of this study was to evaluate the prevalence and severity of periodontal disease in patients with established RA and OA. Materials and Methods: A total of 200 patients reporting to the Department of Orthopaedics, KIMSDU, Karad were included in the study. Patients were divided into two groups: Group 1 that included 100 patients with established RA diagnosed according to American College of Rheumatology (ACR) classification 1987 criteria and Group 2 that comprised 100 patients diagnosed with OA. Demographic profile, medical and dental history, oral hygiene practices, and smoking status of study participants were recorded. Periodontal status of the patients were evaluated using the simplified oral hygiene index (OHI-S), Loe and Silness gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). On the basis of the CAL score periodontitis severity was defined as slight, moderate, and severe. Rheumatoid Factor (RF) and C-reactive protein (CRP) were considered as a serological marker in RA. Serological tests were performed to measure RF and CRP. Periodontal parameters and serological tests were correlated. Results: This study reported 45% severe periodontitis prevalence in RA compared to OA group, which was 33%. Severity of periodontitis is significantly greater in RF positive RA group with mean CAL 5.38 mm compared to RF negative RA group with mean CAL 2.81 mm ( P = 0.001). There was moderate positive correlation found between RF titer and severity of periodontitis (r = 0.311). Conclusion: The severity of periodontitis was significantly higher among the patients with established RA as compared to patients with OA. RF positive patients had higher periodontal disease compared to RF negative patients. There was an increase in the mean clinical attachment loss with increase in RF titer.

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“…Studies for rheumatoid arthritis (RA), inflammatory bowel diseases (IBD) and psoriatic arthritis (PsA) have shown that tight disease control is realistic, feasible, more effective than standard care and cost‐saving in the long run . Especially in RA, the T2T concept has transformed the approach of RA management, including ‘early and aggressive’ treatment …”

Section: Introductionmentioning

confidence: 99%

A Belgian consensus on the definition of a treat‐to‐target outcome set in psoriasis management

Grine

Brassinne

Ghislain

et al. 2020

Acad Dermatol Venereol

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Objective Treat‐to‐target (T2T) is an algorithm to reach a predefined outcome. Here, we define a T2T outcome for moderate‐to‐severe psoriasis vulgaris. Methods Briefly, the study included a literature review, discussions with key opinion leaders, recruitment of additional dermatologists with experience in managing moderate‐to‐severe psoriasis, 3 eDelphi survey rounds and a patient focus group. Relevant topics were selected during discussions prior to the survey for the statements. Surveys were based on the eDelphi methodology for consensus‐building using a series of statements. Consensus was defined as at least 80% of participants agreeing. A psoriasis patient focus group provided feedback on topic selection and outcome. Results A total of 5 discussions were held, and 3 eDelphi rounds were conducted with an average of 19 participants per round. The T2T outcome was set assuming shared decision between patient and dermatologist, awareness and referral for comorbidities by the dermatologist and appropriate treatment adherence by the patient. We defined ‘ideal’ and ‘acceptable’ targets; the latter referring to conditions restricting certain drugs. The T2T outcome was multidimensional, including ≥ ΔPASI90/75 or PGA ≤ 1, itch VAS score ≤ 1, absence of disturbing lesions, DLQI ≤ 1/3, incapacity daily functioning VAS score ≤ 1, safety ≤ mild side‐effects and full/mild tolerability of treatment for the ideal and acceptable target, respectively. Finally, time to achieve the T2T outcome was set at 12 weeks after initiation for all treatments. At all times, safety should not exceed the presence of mild side‐effects. Conclusion With this novel T2T composite outcome for psoriasis, clinicians and patients can make shared decisions on the treatment goals they envisage, as a guidance for future treatment steps – leading to a tight control management of the disease.

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Predictors of sustained remission in patients with early rheumatoid arthritis treated according to an aggressive treat-to-target protocol

Abstract: ClinicalTrials.gov, http://clinicaltrials.gov, NCT01205854.

Cited by 21 publications

References 92 publications

Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018

Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018

Prevalence and severity of periodontitis in patients with established rheumatoid arthritis and osteoarthritis

A Belgian consensus on the definition of a treat‐to‐target outcome set in psoriasis management

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